You can either fill out this form online then print it, or print the form then manually fill it out, then fax to 1-888-690-LOAN
Contact Information Please provide the following contact information:
Applicant Information
Personal Data
Name
Social Security #
Date of Birth
Home Phone #
Are you a U.S. Citizen?
YesNo
Marital Status
Married Unmarried Separated
# of Dependents
Ages of Dependents
Mailing Address
City
State
Zip
Street Address, if above is a PO
Years at address
E-mail
Nearest relative not living with you
Address
Employment Data
Employer
City
State
Zip
Telephone
Position
Annual Salary $
Years
Previous employer
Address
Other Income Annually $
Source
Alimony, child support, or separate maintenance payments are optional and need not be revealed if the Applicant does not choose to rely on such income in applying for credit.
Co-Applicant Information
Name
Social Security #
Date of Birth
Home Phone #
Are you a U.S. Citizen?
YesNo
# of Dependents
Marital Status
MarriedUnmarried Separated
Ages of Dependents
Mailing Address
City
State
Zip
Street Address, if above is a PO
Years at this address
Employer
City
State
Zip
Telephone
Position
Co- Applicant Annual Salary $
Years
Other Co-Income$
Source
Income Information
Applicant/ Co-Applicant net worth
***Notice: Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation
Other income
Paid
Source
Co-applicant income
Paid
Source
Checking account #
Institution
Checking account #
Institution
Landlord or Mortgage Holder
How long at address
Payment
RentBuy
Car Loan Company
Account #
Payment
Is this a Refinance
Yes orNo
If this is a Refi what company holds the loan?
Prior Boat Experience Types of Boats
Boat Data
Year
Manufacturer
Model
Length
State ID (refi)
Type
Engine Type
DieselGas
Horsepower
Single or
Twin engine
Selling Price $
Sales/Use Tax $
Cash Down Payment:$
Trade In $
Amount to Finance $
Financial Statement
Assets
Cash on Deposit
Notes, Mortgages & Trust Deeds Owned
Readily Marketable Securities
Current Boat
Recreational Vehicle
Real Estate Owned (Schedule 1)
Retirement, Pension Fund
Other Assets (List)
Total Assets
Liabilities
Accounts Payable
Notes Payable - Banks
Notes Payable - Others (List)
Installment Contracts Payable (List)
Real Estate Mortgages (Schedule 2)
Total Assets
Net Worth (Total Assets less Total Liabilities)
Total
Schedule 1 - Real Estate Owned
On Parcel No. Sched.
Location & Type of Property
Monthly Income
Purchase Price Date Amount
Valuation This Statement
1
2
3
Total
Schedule 2 - Real Estate Mortgages
On Parcel No. Sched.
To Whom Payable
How Payable
Maturity Date
Amount
1
2
3
Total on this Statement
Add any comments here:
By checking this box you the applicant and co-applicant, if any, make this statement of their assets and liabilities to obtain credit for the financing of the boat described in boat data. The facts in this Personal Financial statement are true as of this dateand may be relied upon by Intercoastal Financial Group, Inc. or any financial institution designated by Intercoastal Group, Inc. Any material changes in the information given prior to closing shall be reported to Intercoastal Group, Inc. Applicant and co-Applicant, if any, authorize Intercoastal Financial Group, Inc. to review the Applicants and Co-Applicant, if any, credit history and employment and to disclose any inquiry in relation with the credit experiences with the applicant and co-applicant.
The information contained in this statement is provided to induce you to extend or to continue the extension of credit to the undersigned or to others upon the guarantee of the undersigned. The undersigned acknowledge and understand that you are relying on the information provided herein in deciding to grant or continue credit or to accept a guarantee thereof. each of the undersigned represents, warrants and certifies that the information provided herein is true, correct and complete. Each of the undersigned agrees to notify you immediately and in writing of any change in name, address, or employment and of any material adverse change(1) in any of the information contained in this statement or (2) in the financial condition of any of the undersigned to perform its (or their) obligations to you. In the absence of such notice or a new and full written statement, this should be considered as a continuing statement and substantially correct. You are authorized to make all inquiries you deem necessary to verify the accuracy of the information contained herein, and to determine the credit-worthiness of the undersigned. each of the undersigned authorizes you to answer questions about your credit experience with the undersigned.
***If Faxing or mailing please remember tosignon the line below. Thank you!
Signed ___________________________________Date__________________